Abstracts

Rationale: There is growing literature on neurological diseases as delayed neurologic effects of the COVID-19 infection. Here, we report a case with insidious onset of generalized intractable epilepsy occurring within a short time frame of the diagnosis of a very mild COVID-19 infection.

Methods: Patient is a 35-year-old healthy male with no past medical history of seizures who initially presented in April 2020 with confusion and headache. Within 24 hours of diagnosis of COVID-19, he had his first seizure with resultant bilateral shoulder dislocations. Patient had no other respiratory or systemic symptoms at the time of his seizure that required hospitalization. Work up at the time of the presentation including MRI was negative. Two weeks later, he had another seizure, once again with resultant shoulder dislocation. Despite progressive titration of AEDs, he continued to have frequent breakthrough seizures. Prolonged Video EEG monitoring confirmed the diagnosis of generalized epilepsy. With the use of high doses of 2 concurrent AEDs, patient has been seizure free for the last few months.

Results: In this case report, we are presenting a new onset generalized epilepsy as a complication of COVID-19 infection. This patient had no other neurological or systematic complication during the acute phase of the illness.

Several case series have reported new onset seizures to be associated with COVID-19 in approximately 1–2% of patients. However, the majority of these cases were associated with severe clinical or neurological complications during the acute course of the illness, especially stroke and hypoxia. Other mechanisms of seizures during COVID-19 illness were proposed to include neurotropism, the entry of pro-inflammatory cytokines into the nervous system, and post-infectious immune-mediated disorders.

Conclusions: To the best of our knowledge, our case is the first to describe generalized epilepsy in connection with very mild COVID-19 infection. In the absence of any other clear risk factor and with potential temporal relationship of the seizures, the association with COVID-19 infection is quite likely. A similar case of focal epilepsy was reported recently in a patient a few weeks after mild COVID infection.

The limitation of this case report is the absence of testing for inflammatory markers including CSF studies at the time of the clinical presentation. Further studies are important to understand the incidence, etiology, response to treatment and prognosis of post-COVID new onset seizure disorder.

Funding: Please list any funding that was received in support of this abstract.: None.